我院慢性疾病患者原研药品使用影响因素分析——治疗慢性病仿制药品一致性评价方向探索

Analysis on the Influence of the Original Patent Drug Usageof Chronic Disease Patients

目的分析不同因素对我院慢性疾病患者是否使用原研药品的影响,促进临床合理使用原研药品,提高我国仿制药品临床疗效,加强我国仿制药品产业发展。方法通过内蒙古自治区人民医院信息系统调取住院患者肺癌、冠心病、高脂血症、脑梗死患者医嘱,对四种疾病患者是否使用原研药品治疗进行Logistic回归分析。结果共收集符合分析条件医嘱30391条,医保患者占比最多的疾病为冠心病7413(61.30%),自费患者占比最多的疾病是肺癌773(55.33%)。结果表明,相同因素在不同疾病产生结果是不同的,肺癌患者中医保患者使用原研药品较多(OR=1.379,P<0.05),其他疾病自费患者使用原研药品较多,其中,高血脂症、冠心病患者支付方式对原研药品影响均为为负向(OR=0.650,P<0.001;OR=0.815,P=0.008)。其他癌症并发症患者使用原研药品增加。在所有慢性病中,随着抗生素、注射剂使用增多,住院天数的增加,原研药品使用增多。结论不同疾病对原研药品使用有不同影响,其他因素如医保关系、抗菌药物、注射剂使用等都会对原研药品是否使用产生影响。我国在2018年开展仿制药一致性评价,研究结果对于我国一致性评价政策实施及工作推进有重要意义,也可以侧面地向国内医生表明针对某些疾病国内仿制药的治疗疗效并不劣于进口的原研药物,医保支付方面予以适当支持,医保机构应优先采购并在临床中优先选用。对脑梗死、肿瘤、高脂血症等慢性疾病,可以推动治疗此类疾病仿制药品质量提高,鼓励更多仿制药品进行一致性评价,加速治疗此类疾病药品一致性评价进程。

OBJECTIVE The study selects typical chronic diseases patients in representative hospitals in Inner Mongolia.Toimproverational drug use, analyzing effect of different factors on drug cost in patients with fourtypical chronic diseases.METHODS A population-based retrospective cross-sectional study was carried out on drug expenditures of patients with our typical chronic diseasesfrom Inner Mongolian People′s Hospital.The dependent variable wasthe original patent drug usage whether or not.RESULTS The same factors produce different results in different diseases, medical insurance patients use more the original patent drug.Antibiotics, injections and inpatient days usage result in more the original patent drug usage.CONCLUSION Theoriginal patent drug usage was influenced by differentdiseases, imply that the insurance type does impact physicians′ prescription behaviors to some extent.The positive effects of insurance schemes on expenditure and appropriate use of medicines may rest on the long-term effects of promoting rational use of drugs and therapeutic effect of generic drug.